BVA9503127
DOCKET NO. 90-52 365 ) DATE
)
)
On appeal from the decision of the
Department of Veterans Affairs Regional Office in St. Petersburg,
Florida
THE ISSUE
Entitlement to service connection for an acquired psychiatric
disorder.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
G. Wm. Thompson, Counsel
INTRODUCTION
The veteran had active service from July 1972 to August 1973.
In February 1976, the RO denied service connection for a nervous
disorder. It does not appear that the appellant was properly
notified of the action. As the claim is still active, a decision
will be rendered on a de novo basis.
The issue of entitlement to service connection for a psychiatric
disorder was previously before the Board of Veterans' Appeals
(Board) in May 1991, April 1992, and March 1994, and on those
occasions, the case was remanded for additional development. The
Department of Veterans Affairs (VA) St. Petersburg, Florida,
Regional Office (RO) has returned the case to the Board for
further appellate consideration.
Extensive efforts have been made in this case to secure
additional records. With the receipt of records from Columbia
Area Mental Health Center in June 1994, and their assurance that
the location of the clinicians that treated the veteran in the
early 1970's is unknown, it is believed that there are no further
reasonable avenues for development and this case will be
considered on the basis of the evidence of record.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran asserts that the RO erred in not finding that the
evidence of record supports a grant of service connection for an
acquired psychiatric disorder. She reports that she required
psychiatric care in service, and that psychiatric care continued
after service, to the present.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter, and
for the following reasons and bases, it is the decision of the
Board that the preponderance of the evidence is against a grant
of service connection for an acquired psychiatric disorder.
FINDINGS OF FACT
1. Evidence sufficient for an equitable disposition of the
veteran's appeal has been obtained by the RO.
2. The veteran had symptoms including anxiety and depression in
service; the diagnosis was situational adjustment reaction.
3. The veteran received private and VA treatment for personality
disorders and adjustment problems after service.
4. An acquired psychiatric disorder was not demonstrated in
service; was first diagnosed in the mid-1980's; and a psychosis
was not manifested to a compensable degree within one year after
service.
5. The instant case does not involve such an unusual or complex
medical question as to require an opinion from an independent
medical expert outside the VA.
CONCLUSIONS OF LAW
1. The present case does not involve such medical complexity or
controversy so as to require the Board to obtain an independent
advisory or expert medical opinion outside the VA. 38 U.S.C.A.
§ 7109(a) (West 1991).
2. An acquired psychiatric disorder was not incurred in or
aggravated by active military service; and a psychosis may not be
presumed to have been incurred therein. 38 U.S.C.A. §§ 1101,
1110, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.303(a)(c)(d),
3.307, 3.309 (1994).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The veteran's claim is well-grounded and the VA has met its duty
to assist by obtaining or attempting to obtain all relevant
evidence. The requirements mandated by 38 U.S.C.A. § 5107(a)
have been fulfilled.
When, in the judgment of the Board, expert medical opinion, in
addition to that available within the Department, is warranted by
the medical complexity or controversy involved in an appeal case,
the Board may secure an advisory medical opinion from one or more
independent medical experts who are not employees of the
Department. 38 U.S.C.A. § 7109(a) (West 1991).
Basically, the applicable law and regulations provide that
service connection can be established if a particular disease or
injury, resulting in disability, is incurred coincident with
service, or if a chronic disease, as specified in 38 U.S.C.A.
§ 1101, is manifested to a compensable degree within one year
thereafter. Congenital or developmental defects as such are not
diseases or injuries within the meaning of applicable
legislation. 38 U.S.C.A. §§ 1110, 1112, 1113, 1137; 38 C.F.R.
§§ 3.303, 3.307, 3.309 (1994).
History
The veteran's service medical records show that in November 1972,
she was seen at a base clinic complaining of anxiety after she
had difficulty adjusting to life in the barracks. She was
referred to a psychiatrist who found no psychiatric disorder.
She was returned to duty. In June 1973, she was seen at a base
clinic for agitation. She had received a court martial a day
earlier. Situational anxiety was noted and Valium was
prescribed. Situational reaction was the diagnosis in July 1973,
after she complained of diffuse anxiety, insomnia and an
inability to concentrate. In late July 1973, situational
difficulties were noted. she was thought to have psychosomatic
problems due to exogenous depression. She was considered a
suicide risk. Three days before her separation from service, in
August 1973, she was noted to be very hyper - anxiety reaction
was noted and Valium was prescribed. Her service records
indicated that while in service she received a court martial and
had difficulties generally associated with disciplinary problems.
She was discharged for unsuitability.
After service, a private physician referred the veteran to the
Columbia Area Mental Health Center, where she presented with
symptoms including depression. Passive aggressive personality
was diagnosed, and she received outpatient treatment from
November 1973 to July 1974. VA records show that in the mid
1970's she was hospitalized and received treatment for schizoid
personality involving various traits. In the mid-1980's she was
described as having a borderline and inadequate personality,
adult situational adjustment problems and adult adjustment
reaction with depressed mood. In the 1984, depressive neurosis
was diagnosed, along with diagnosis of adjustment disorder and a
personality disorder. VA outpatient clinic records show that in
November 1988 the diagnostic impressions for the veteran were
alcohol and sedative dependence. During a June 1991 VA
hospitalization, a bipolar disorder was noted. A psychiatric
examination for the veteran, requested by the Board and conducted
in May 1992, showed an Axis I diagnosis of bipolar disorder, and
an Axis II diagnosis of a personality disorder.
Summary
Whatever the veteran's problems in service, the evidence of
record does not show that she had an acquired psychiatric
disorder. The symptoms of anxiety and depression were associated
with the situational adjustment reaction diagnosed in service,
all related to her court martial and various disciplinary
problems. The Board notes that information recorded for clinical
purposes indicates that she reported some problems with
depression prior to service. This information has been gleaned
from various histories as provided by the veteran. Depression
was one of several symptoms reported during service and after
service, and there is no objective medical evidence to show that
it was more than a manifestation of the situational adjustment
problem, and her personality disorder. It is for consideration
that when treated shortly after service, the diagnosis was a
personality disorder A bipolar disorder, a psychosis, was first
diagnosed many years following her separation from service.
Recent diagnoses for the veteran still include a personality
disorder A personality disorder is not a disease or disability
for VA compensation benefit purposes. 38 C.F.R. § 3.303(c).
Furthermore, as pointed out earlier, it was approximately a
decade after the veteran's active service before an acquired
psychiatric disorder was found. There is no medical evidence
showing that the post-service acquired psychiatric disorder is
related in any manner to the veteran's active military service.
There is no basis for an award of service connection for an
acquired psychiatric disorder. 38 U.S.C.A. §§ 1101, 1110, 1112,
1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309.
The Board would note, with respect to the contentions raised by
the representative in connection with the present appeal, that
the instant case does not present such a complex or controversial
medical question as to warrant its submission to an independent
medical expert, outside the VA framework, for an opinion. The
Board finds that the scope of the medical issue presented in this
case falls within the area of rating judgment and that the Board
has appropriately carried out its appellate function.
ORDER
Service connection for an acquired psychiatric disorder is
denied.
RENÉE M. PELLETIER
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals within
120 days from the date of mailing of notice of the decision,
provided that a Notice of Disagreement concerning an issue which
was before the Board was filed with the agency of original
jurisdiction on or after November 18, 1988. Veterans' Judicial
Review Act, Pub. L. No. 100-687, § 402 (1988). The date which
appears on the face of this decision constitutes the date of
mailing and the copy of this decision which you have received is
your notice of the action taken on your appeal by the Board of
Veterans' Appeals.